Dr. Paul Milling says Palomar Medical Center's lack of a separate labor and delivery operating-room team results in other surgeries being delayed.

Palomar Medical Center needs more operating-room staff to improve patient care and safety, retain employees and improve workplace morale, according to a petition signed by at least 144 physicians and hospital employees.

The petition is to be presented to the board that oversees the Escondido hospital at its meeting Monday night.

A high number of emergency procedures are added daily at Palomar. This delays previously scheduled surgeries into the late evening or early morning, when they must be performed by "tired doctors and staff," orthopedic surgeon Dr. Paul Milling wrote in a letter last month to Palomar's board and administrators. Milling is circulating the petition.

The delays stem mainly from Palomar's lack of a separate operating-room team to deliver an average of 378 babies per month, Milling said. Some of these procedures must be performed within three minutes as emergency Caesarean sections to prevent birth defects or suffocation for the baby.

"If they had resources, patients' (surgeries) wouldn't get bumped by C-sections and they wouldn't have to wait and wait and wait – often in pain," Milling said.

McKinley, an orthopedic surgeon, said Milling's letter is "slightly melodramatic" but on the right track.

"Palomar is the only hospital (in San Diego County) that doesn't have its own designated OB (obstetrical) operating room and OB designated staff," he said yesterday.

The hospital isn't about to collapse in chaos, McKinley said, "but we want to get enough staff that we don't burn out people." He added that Milling's letter "is a good way of helping the upper echelons of the board appreciate that there's this need."

On average, Palomar handles 12 to 16 non-scheduled surgeries a day, more than twice what a hospital its size should have, McKinley said.

Tony Coletti, an administrator for the state agency that licenses hospitals, said California regulations don't address the issue of hospital obstetrical units or delays in surgical scheduling. Coletti said the issue "sounds interesting, and I feel we should take a look at it."

If Palomar doesn't increase staffing, Milling wrote, "it is only a matter of time when one of these avoidable late-night and early-morning cases will turn into another nationally known, tragic surgical embarrassment for (the hospital) such as 'The Retractor Left in the Abdomen.' "

Milling was referring to an incident in 2000 when a Palomar surgeon – operating late on what was termed "a marathon day" of procedures – forgot to remove a 14-inch metal device from the stomach of patient Dan Jennings. The retractor wasn't detected for several weeks and, in a lawsuit, Jennings said he suffered a massive infection from flesh-eating bacteria because of it.

Jennings, who since has moved to Nashville, said recently by phone that he hasn't fully recovered.

Most facilities offering labor and delivery services have a dedicated obstetrical team and an anesthesiologist on duty around the clock, Milling and officials from several major hospitals in San Diego County said.

In contrast, Palomar has a separate obstetrical anesthesiologist from 7 a.m. to 7 p.m. on weekdays only, or only about one-third of the time.

Palomar's sister hospital, Pomerado Hospital in Poway, has a dedicated labor and delivery team even though only 100 babies are delivered there, Milling said.

"Why are Palomar mothers and babies not treated equally and as safely as Pomerado mothers and babies?" he wrote.

In his letter, Milling gave one example of a trauma patient who arrived with an open thigh-bone fracture at 7 p.m. The patient's surgery was delayed until 11:30 p.m. because three C-sections were added, monopolizing the surgical team.

Dr. Gary Vilke, medical director for San Diego County's Emergency Medical Services and an emergency room physician at the UCSD Medical Center, said having a patient get bumped is frustrating.

"(The doctors) make plans, they have other cases, and it's upsetting," Vilke said.

But a three-or four-hour delay "does not seem outside the realm of what is normal for the (medical) community," Vilke said. He and several trauma specialists at other hospitals said that waits up to six hours are common.

Vilke noted that general surgeons and orthopedic doctors are typically exasperated because their cases tend to get bumped the most.

Most Palomar Pomerado Health board members did not respond to calls requesting comment. Ted Kleiter said he never received Milling's letter, and Dr. Marcelo R. Rivera said he referred the letter to the hospital district's chief executive officer, Michael Covert.

As of yesterday, Milling continued gathering signatures on his petition to Covert and the board. It has been signed by at least 15 physicians. The petition reads: "We believe Palomar (operating room) needs increased staffing to provide better patient care, safety, increased staff retention and improvement of hospital and medical staff morale."

Milling said those who signed the petition did not see the letter that he had sent to the board.

One of the signers, thoracic surgeon Dr. Jeffrey Rosenburg, said the issue does not affect heart surgeries. Rosenburg said he signed the petition in support of nurses and other employees who are "unhappy that they don't have enough personnel to staff the operating rooms, so (the hospital) has to get outside personnel, such as travelers nurses, and they make more money," he said.